RN Clinical Reimbursement Specialist

Join our team as a RN Clinical Reimbursement Specialist at INTEGRIS HEALTH 5300 Building, in Oklahoma City, OK.Get to Know Your TeamINTEGRIS Health, Oklahoma's largest not-for-profit health system, is seeking a dedicated caregiver to join us in our mission to partner with people to live healthier lives.Benefits of being an INTEGRIS Health caregiver include front-loaded PTO, medical benefits through the extensive INTEGRIS Health network, financial assistance for continued education, 24/7 mental health support and more.Take the first step toward growing your career by joining us.The RN Clinical Reimbursement Specialist is responsible for identifying and preparing clinical appeals for government, managed care organizations, and various other payors. Provides assistance and guidance in the maintenance of the charge description master for the INTEGRIS Health system. INTEGRIS is an Equal Opportunity/Affirmative Action Employer. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.The RN Clinical Reimbursement Specialist responsibilities include, but are not limited to, the following:Assists the Director of Revenue Recovery in the training and development of all INTEGRIS recovery staff related to clinical and non-clinical payment issuesOversees and manages the INTEGRIS System clinical denial management processIdentifies inaccurate and/or problematic denial and payment trends and assists with the development of a plan to insure facilities receive maximum reimbursementParticipates in Utilization Management Committee for all INTEGRIS facilities to report denial issues and develop preventive strategies in collaboration with the physiciansAnalyzes, prepares and distributes monthly denial reports to Vice Presidents, Directors and Managers of specified hospital departmentsResponds to utilization management clinical denials issued by government contracted vendors for the Medicare and Medicaid programsSupports Case Management and other hospital departments with clinical expertise in regards to both payor and patient clinical denial inquiriesAssists the Chargemaster Consultant in the development, implementation, maintenance and audit functions related to the chargemaster description master.Analyzes denial trends for documentation or charging issue opportunities and facilitates cross-departmental collaboration to improve processes and develop best practices.Identifies charging, coding or clinical documentation issues and works with ancillary departments to resolve issues and notify appropriate leadership.Educates and maintains effective and practical knowledge of government and managed care payer rules, regulations and requirements.Reports to assigned Corporate Manager. This position may have additional or varied physical demand and/or respiratory fit test requirements. Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information. Minimal. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.INTEGRIS Health is an Equal Opportunity Employer. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.Current licensure as a Licensed Practical Nurse (LPN) or Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state and 8 years experience working with healthcare facilities, health insurance or managed care companies, and 10 years demonstrated experience working with healthcare facilities, health insurance or managed care companies6 years of direct managed care or case management experienceKnowledge and proficiencies with government rules and regulations, managed care contracts, provider relations, pre-certification, reimbursement, financial analysis, and patient accountingKnowledge of legal documents, collection agency procedures, and contract documentsMust be able to communicate effectively in English (Verbal/Written)